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As the Southeast braces for another Category 4 hurricane, abortion providers in the region are still grappling with the toll Helene took on patients’ already tenuous access to the procedure. 

Clinics have closed in states like North Carolina and Georgia, impassable roads and power outages have delayed delivery of abortion pills and the complicated travel logistics for the time sensitive and costly procedure were made even more difficult by the Category 4 hurricane. 

In Asheville, the only clinic in the western part of the state has been shuttered due to flooding and storm damage. While electricity has been restored, there is still no running water, according to Molly Rivera, a spokesperson for Planned Parenthood South Atlantic, which oversees the clinic. 

“We can’t operate without water,” she said. “At this point we don’t know when we’ll be able to reopen.” 

The closure of the clinic has implications for patients both in the city and well beyond it. It was an important access point for Tennessee, which has a near-total abortion ban. North Carolina outlaws the procedure after 12 weeks. 

“Asheville has been an important access point for reproductive health care for the entire region,” Rivera said. “It is very rural … so it has been one of the few places to provide reproductive health care like birth control and cancer screenings, and it has been the only place to get an abortion for all of that region of North Carolina.” 

Now, people will have to travel even further. 

In Georgia, ARC-Southeast, an Atlanta-based nonprofit that provides funding and travel support for abortions throughout the region, said that some clients had to miss or reschedule appointments as a result of the hurricane. That isn’t merely an inconvenience. 

“I had a caller who might miss her only chance to receive an abortion by one day, because the hurricane made it too dangerous to drive and she had to shelter in place,” said Kenny, a healthline coordinator who withheld her full name to avoid harassment.

The organization’s own capacity to help clients was limited during the hurricane as they took care of friends, family and themselves. They reopened Tuesday, five days after the hurricane had passed through. But even then Kenny worried that power outages caused by the storm were affecting people’s ability to contact the nonprofit over the phone.

Advocates and clinic workers told The 19th they are worried about people progressing too far in their pregnancy and being unable to access the procedure because of strict bans in states hit hard by Helene. Those laws have forced many patients seeking abortions to travel out of state for care — an often-difficult task even without the added layer of severe weather damage and clinic closures. 

In addition to the 12-week ban, North Carolina requires patients to make two in-person visits to a clinic separated by 72 hours — a high barrier for those traveling long distances for abortion even before the hurricane swept through. In Florida, abortion is illegal after six weeks of pregnancy, and patients must have two in-person clinic visits separated by 24 hours. Georgia also bans abortion after six weeks of pregnancy, though the law was temporarily blocked by a state court ruling between September 30 and October 7. While some clinics resumed providing abortions after six weeks in the state, others did not.

A Preferred Women’s Health Center in Augusta, Georgia, which has been shuttered since Helene hit, said their closure has impacted people’s ability to access abortion past the six-week ban. One way the clinic has helped Georgia patients navigate the 72-hour waiting period in North Carolina is by offering the initial patient visit required by the state at their clinic. But with one of their two clinics closed, it curtails even that option. 

“The one little Band-Aid we found just got ripped off,” said Calla Hales, the clinic’s executive director.

And each additional barrier can make it more costly to get an abortion. Serra Sippel, the interim executive director with the Brigid Alliance, an organization that provides logistical and financial support for people getting abortions in the South, said that the further along people are in their pregnancies, the costlier the procedure gets. That will burden abortion funds, which give money to those who otherwise could not afford to travel out of state or pay for things like hotels or flights. 

“They were stretched already and in need of support, and now, with the disaster, even more so,” Sippel said.

And people seeking an abortion who’ve been directly impacted by the hurricane may now have to make a choice between their own recovery — thousands of people have lost homes or have had to evacuate — and coming up with money for the procedure.

“They’re being faced with those tough financial decisions on whether they can even use those funds to get the abortion they need, and funds that they may need to deal with a disaster and recovery at home,” she said. 

In-clinic visits aren’t the only services impacted, said Melissa Grant, chief operations officer with carafem, which operates abortion clinics in Maryland, Georgia and Illinois. They have seen numerous logistical hurdles for patients after Helene. Carafem sends abortion medication in the mail, and Grant said that people often designate a weekend to take the pills, sometimes booking a hotel to ensure some privacy or to take time away from their own children. 

“People really make pretty significant and detailed plans about how to make this work best for them,” she said. 

But during and after the hurricane, particularly in more conservative states, patients might instead be sheltering with family members or friends who don’t support abortion. If they do take the pills, their access to emergency care in the event something goes wrong may also feel more limited in states where clinics and support organizations are dealing with power outages or damage. 

“With the stigma of abortion it has made it so that people are reluctant to reach out to other types of health care providers with questions in their area,” Grant said.  

Even getting the medication itself has been delayed for some patients. Carafem has a pharmacy in North Carolina that dispenses the abortion pills via mail, and it lost power for a few days and was unable to process orders on Thursday and Friday of the week the hurricane hit. Even though service has been restored, companies like UPS and FedEx are facing their own delays in deliveries due to flooded towns and impassable roads. 

“Medications are something where people are watching the minutes,” she said. 

Stateline Abortion Access Partners, a Virginia-based collective of activists that helps people from states like Tennessee and North Carolina get abortions across the state line, is also worried about an uptick in residents who might need abortions in a few weeks due to the disaster. 

“There are people that had to evacuate and leave their contraception behind or not get their depo shot [a form of birth control],” said Barbara Schwartz, who volunteers as a clinic escort with Stateline Abortion Access Partners. “There are people that are essentially having comfort sex because there’s no power and no internet. And then there’s also people that may be being assaulted because they’re in transitional situations. So I really, really worry about those people. We all worry about those people.”

Her organization is focused on getting sexual and reproductive health supplies to people who are isolated by damaged roads, or not able to access basic resources. So far, they’ve been successful in distributing some supplies, but they have to be careful with determining which disaster relief agencies to partner with. 

“Some of the agencies around here are church based,” she said. “We don’t want to hand over an expensive case over of Plan B to someone who says, ‘Oh, that’s disgusting. That’s an abortifacient, and bury it in the basement or throw it in a dumpster somewhere,’” Schwartz said.  

As activists like Schwartz try to lessen the impact from Helene, the region is bracing for Hurricane Milton, which is expected to make landfall in Florida by Wednesday. 

“Florida is about to get completely just slammed by this and we’re already so stretched,” said Hales of the Preferred Women’s Clinic. “North Carolina is already taking on a lot of weight in terms of abortion care for a lot of these Southern states. Losing what little care they could have in state is still going to make a huge impact.”

“When you have something like a hurricane that comes in, it just radically skews a schedule, because there’s no way to bank on having power, there’s no way to know how long it’s going to take for a clinic to get replacement supplies or for roads to be restored,” she added. “Mother Nature doesn’t give a shit about the timing you need.”

Shefali Luthra contributed to this report.